Medicare Membership & Eligibility Analyst – Temporary

🔥 24 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $34k - $48k / hour

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Central California Alliance for Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1996

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Central California Alliance for Health is a regional non-profit healthcare organization that provides Medi-Cal managed care services to residents in several Central California counties, including Mariposa, Merced, Monterey, San Benito, and Santa Cruz. The organization offers a wide range of health services, including primary care, behavioral health, pharmacy support, and disease management, focusing on improving member coordination of care and access to health services. Central California Alliance for Health also engages with communities through grants and partnerships to enhance healthcare accessibility and quality. The organization supports members with services such as dental and vision care, family planning, transportation, and language assistance. Additionally, it provides resources for health education, telehealth services, and complex case management.

📋 Description

• Supports Medicare operations, sales, and enrollment functions through analysis and interpretation of Medicare and Medi-Cal data and ensures compliance with applicable state and federal regulations • Conducts complex research and analysis in support of Medicare Operations activities • Acts as a subject matter expert and liaison to internal and external stakeholders

🎯 Requirements

• Knowledge of CMS guidelines related to Medicare sales and enrollment • Knowledge of Medicare Advantage enrollment processes and financial reconciliation • Knowledge of contents and interpretation of monthly membership reports • Knowledge of research, analysis, and reporting methods • Knowledge of data analysis tools, CRM/enrollment systems, and the use of databases • Ability to analyze complex data sets and present actionable insights • Ability to identify issues, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action • Ability to interpret, explain and apply applicable policies, laws, codes, regulations, and contracts • Ability to organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines • Ability to assist with the development and implementation of projects, systems, programs, policies, and procedures • Ability to develop and implement operational workflows • Bachelor's degree in Business Administration, Health Care Administration, Public Health, or a related field • Minimum of five years of progressively responsible experience related to Medicare membership operations and/or enrollment eligibility • Master’s degree may substitute for two years of the required experience; or an equivalent combination of education and experience may be qualifying.

🏖️ Benefits

• Medical, Dental and Vision Plans • Ample Paid Time Off • 12 Paid Holidays per year • 401(a) Retirement Plan • 457 Deferred Compensation Plan • Robust Health and Wellness Program • Onsite EV Charging Stations